title: Eradication of Helicobacter pylori according to 23S ribosomal RNA point mutations associated with clarithromycin resistance.
abstract: BACKGROUND
  Clarithromycin-resistant Helicobacter pylori is associated with point mutations in the 23S ribosomal RNA (rRNA) gene.
  
  
  METHODS
  A total of 1232 patients participated and were divided into 2 control groups and 1 case group. Patients in the APC control group, which consisted of 308 randomly assigned participants, were treated with standard triple therapy, consisting of amoxicillin, rabeprazole, and clarithromycin; 308 participants in the APM control group were treated with amoxicillin, rabeprazole, and metronidazole. For the 616 participants in the case group, a test for point mutations in the 23S rRNA gene of H. pylori was conducted. A total of 218 individuals in the case group received a new tailored therapy regimen, in which amoxicillin, rabeprazole, and clarithromycin were given in the absence of a mutation, whereas clarithromycin was replaced by metronidazole if the mutation was detected.
  
  
  RESULTS
  The rate of eradication of H. pylori in the tailored group was 91.2% (176/193), which was significantly higher than that in the APC (75.9% [214/282]; P < .001) and APM (79.1% [219/277]; P < .001) control groups.
  
  
  CONCLUSIONS
  The rate of H. pylori eradication among patients who received tailored therapy on the basis of detection of a clarithromycin resistance mutation by polymerase chain reaction was much higher than the rate among patients who received a standard triple therapy regimen.
  
  
  BACKGROUND
  NCT0145303.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul.
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Jin Il
authors.initials: JI
authors.lastname: Kim
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Cheung
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Kim
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Jun
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Oh
authors.forename: Woo Chul
authors.initials: WC
authors.lastname: Chung
authors.forename: Byung-Wook
authors.initials: BW
authors.lastname: Kim
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Kim
authors.forename: Soo-Heon
authors.initials: SH
authors.lastname: Park
authors.forename: Jae Kwang
authors.initials: JK
authors.lastname: Kim
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D017354:Point Mutation; D016133:Polymerase Chain Reaction; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012338:RNA, Ribosomal, 23S / Q000235:genetics*; D064750:Rabeprazole; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D012338:RNA, Ribosomal, 23S; D008795:Metronidazole; D064750:Rabeprazole; D000658:Amoxicillin; D017291:Clarithromycin
keywords: Clarithromycin; Helicobacter pylori; drug resistance; point mutation